Faecal microbiota transplantation and bacteriotherapy for recurrent Clostridium difficile infection: A retrospective evaluation of 31 patients
Faecal microbiota transplantation and bacteriotherapy for recurrent Clostridium difficile infection: A retrospective evaluation of 31 patients
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DOI：
10.3109/00365548.2013.858181
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发表时间：
2014-02-01
影响因子：
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通讯作者：
Ung, Kjell-Arne
中科院分区：
文献类型：
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作者：
Emanuelsson, Frida;Claesson, Berndt E. B.;Ung, Kjell-Arne
背景：复发性艰难梭菌感染（CDI）是一个重要的问题，由于其发病率和严重程度增加。标准抗生素治疗的失败率很高。在我们医院，粪便微生物群移植（FMT），或在盐水中滴注已知肠道细菌的培养混合物作为直肠细菌疗法（RBT），长期以来一直被用作复发性疾病患者的“抢救疗法”，其中重复的标准抗生素治疗失败。我们想评估FMT和RBT对复发性CDI的有效性。方法：回顾性分析31例复发性CDI患者接受FMT或RBT治疗的临床资料。FMT基于近亲的粪便捐赠，RBT基于最初从健康人分离的10种单独培养的肠道细菌菌株的限定盐水混合物。两种类型的滴注都通过直肠导管进行。FMT（500 ml）作为1次安装。RBT（200 ml）为2或3次安装，疗程之间间隔2天。治疗成功定义为3天内症状持续消失和腹泻停止。结果：31例患者中，23例（74%）对治疗成功：16/23例（70%）接受FMT，7/8例（88%）接受RBT。结论：我们发现FMT对复发性CDI患者有效。基于预定义细菌悬液的RBT与基于粪便捐献的FMT一样有效或更好;然而，可能需要多次安装。
Background: Recurrent Clostridium difficile infection (CDI) is a significant problem due to its increased incidence and severity. Failure rates for standard antibiotic therapies are high. In our hospital, faecal microbiota transplantation (FMT), or instillation of a culture mixture of known enteric bacteria in saline as rectal bacteriotherapy (RBT), has long been used as 'rescue therapy' in patients with recurrent disease, in whom repeated courses of standard antibiotic treatment have failed. We wanted to evaluate the effectiveness of FMT and RBT for recurrent CDI. Methods: The records of 31 patients treated with either FMT or RBT for recurrent CDI were reviewed retrospectively. FMT was based on faecal donation by a close relative and RBT on a defined saline mixture of 10 individually cultured enteric bacterial strains originally isolated from healthy persons. Both types of instillation were carried out through a rectal catheter. FMT (500 ml) was given as 1 installation. RBT (200 ml) was given as 2 or 3 installations with an interval of 2 days between courses. Treatment success was defined as a sustained loss of symptoms and discontinuation of diarrhoea within 3 days. Results: Of 31 patients, 23 (74%) responded successfully to the treatment: 16 of 23 (70%) receiving FMT and 7 of 8 (88%) receiving RBT. Conclusion: We found FMT to be effective in patients with recurrent CDI. RBT based on a predefined bacterial suspension was as effective as or better than FMT based on faecal donation; however, multiple installations may be needed.